Abstract
BACKGROUND: Albumin is supposed to be associated with cancer risk. However, evidence on serum albumin and cancer risk among the Chinese population is sparse. This study was conducted to evaluate the association between pre-diagnostic serum albumin and cancer risk among Chinese. METHODS: A total of 82,061 participants with baseline information on serum albumin concentration in the Kailuan cohort were recruited. Cox proportional hazards models and restricted cubic spline (RCS) analyses were used to evaluate the association between pre-diagnostic serum albumin and cancer risk. RESULTS: Albumin levels were inversely associated with overall cancer risk (HR [95% CI]: Q2, Q3, Q4 vs. Q1: 0.91 [0.78-1.07], 0.80 [0.70-0.92], 0.73 [0.63-0.85]), and the risk of lung, colorectal, and liver cancer (HR [95% CI]: Q4 vs. Q1: lung: 0.70 [0.52-0.95], colorectal: 0.43 [0.26-0.72], liver: 0.59 [0.36-0.95]). After excluding new cancer cases within 2 years since enrollment, a more significant association was observed for liver cancer (HR [95% CI]: Q4 vs. Q1: 0.41 [0.21-0.78]), while associations converted to nonsignificant for lung and colorectal cancer. The RCS model suggested an inverse linear association between albumin and the risk of overall cancer (p-overall < 0.0001, p-nonlinear = 0.3716) and liver cancer (p-overall = 0.0002, p-nonlinear = 0.1807). CONCLUSIONS: Our findings suggest that pre-diagnostic serum albumin is inversely and linearly associated with cancer risk among the Chinese population. This study provides evidence that albumin may be valuable to the prediction and stratification of cancer risk in the general population. However, the biological mechanism and clinical significance remain to be elucidated. Population studies with longer follow-up time as well as experimental studies are further required.